Coiled antenna with fluid cooling

ABSTRACT

An energy delivery system comprises a transmission member and an antenna at a distal end of the transmission member. The antenna includes a first conductive arm, an insulator extending around the first conductive arm, and a second conductive arm. The second conductive arm includes a coil. The system also comprises a barrier layer surrounding the transmission member and antenna. The barrier layer extends from a proximal portion of the transmission member to a distal portion of the antenna. The system also comprises a jacket surrounding the barrier layer and forming a fluid channel for receipt of a cooling fluid.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application62/754,976 filed Nov. 2, 2018 and U.S. Provisional Application62/858,719 filed Jun. 7, 2019, all of which are incorporated byreference herein in their entirety.

FIELD

The present disclosure is directed to minimally invasive ablationsystems and methods of use.

BACKGROUND

Minimally invasive medical techniques are intended to reduce the amountof tissue that is damaged during medical procedures, thereby reducingpatient recovery time, discomfort, and harmful side effects. Suchminimally invasive techniques may be performed through natural orificesin a patient anatomy or through one or more surgical incisions. Throughthese natural orifices or incisions, an operator may insert minimallyinvasive medical tools to reach a target tissue location. Minimallyinvasive medical tools include instruments such as therapeutic,diagnostic, biopsy, and surgical instruments. Minimally invasive medicaltools may also include ablation instruments. Ablation instrumentstransmit energy in the form of electromagnetic waves to a targeted areaof tissue, such as a tumor or other growth, within the patient anatomyto destroy the targeted tissue. Some minimally invasive medical toolsand ablation instruments may be teleoperated or otherwisecomputer-assisted. Various features may improve the effectiveness ofminimally invasive ablation instruments.

SUMMARY

Embodiments of the invention are best summarized by the claims thatfollow the description.

In some examples, an energy delivery system comprises a transmissionmember and an antenna at a distal end of the transmission member. Theantenna includes a first conductive arm, an insulator extending aroundthe first conductive arm, and a second conductive arm. The secondconductive arm includes a coil. The system also comprises a barrierlayer surrounding the transmission member and antenna. The barrier layerextends from a proximal portion of the transmission member to a distalportion of the antenna. The system also comprises a jacket surroundingthe barrier layer and forming a fluid channel for receipt of a coolingfluid.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory innature and are intended to provide an understanding of the presentdisclosure without limiting the scope of the present disclosure. In thatregard, additional aspects, features, and advantages of the presentdisclosure will be apparent to one skilled in the art from the followingdetailed description.

BRIEF DESCRIPTIONS OF THE DRAWINGS

FIG. 1 is a perspective view of an energy delivery system for tissueablation with an antenna coupled to a transmission member according tosome embodiments.

FIG. 2A is a cross-sectional side view of an energy delivery system witha fluid cooling system and a jacket including a balloon portion.

FIG. 2B is a cross-sectional side view of an energy delivery system witha fluid cooling system and a jacket including a balloon portion.

FIG. 3A is an exploded cross-sectional side view of an energy deliverysystem according to some embodiments.

FIG. 3B is an assembled cross-sectional side view of the energy deliverysystem of FIG. 3A.

FIG. 3C illustrates a monolithic jacket and tip structure according tosome embodiments.

FIG. 3D illustrates a jacket and tip structure according to someembodiments.

FIG. 4A is a cross-sectional side view of an energy delivery system witha fluid cooling system and a pair of fluid conduits.

FIG. 4B is a cross-sectional end view of an energy delivery system ofFIG. 4A with a fluid cooling system and a pair of fluid conduits.

FIG. 5 is a cross-sectional end view of an energy delivery system with aD-shaped fluid channel.

FIG. 6 is a cross-sectional end view of an energy delivery system with aplurality of dividers extending within a fluid channel to provideradially arranged inlet and outlet sub-channels within the fluidchannel.

FIG. 7 is a cross-sectional end view of an energy delivery system with adivider extending with a fluid channel to provide concentric inlet andoutlet sub-channels within the fluid channel.

FIG. 8 is a cross-sectional end view of an energy delivery system with aplug preventing fluid migration.

FIG. 9 is a flowchart illustrating a method of ablation according tosome embodiments.

FIG. 10 is a simplified diagram of a teleoperated medical systemaccording to some embodiments.

FIG. 11A is a simplified diagram of a medical instrument systemaccording to some embodiments.

FIG. 11B is a simplified diagram of a medical instrument with anextended medical tool according to some embodiments.

FIG. 12 illustrates a method for manufacturing an energy deliverysystem.

FIG. 13 illustrates a method for manufacturing an energy deliverysystem.

Embodiments of the present disclosure and their advantages are bestunderstood by referring to the detailed description that follows. Itshould be appreciated that like reference numerals are used to identifylike elements illustrated in one or more of the figures, whereinshowings therein are for purposes of illustrating embodiments of thepresent disclosure and not for purposes of limiting the same.

DETAILED DESCRIPTION

In the following description, specific details are set forth describingsome embodiments consistent with the present disclosure. Numerousspecific details are set forth in order to provide a thoroughunderstanding of the embodiments. It will be apparent, however, to oneskilled in the art that some embodiments may be practiced without someor all of these specific details. The specific embodiments disclosedherein are meant to be illustrative but not limiting. One skilled in theart may realize other elements that, although not specifically describedhere, are within the scope and the spirit of this disclosure. Inaddition, to avoid unnecessary repetition, one or more features shownand described in association with one embodiment may be incorporatedinto other embodiments unless specifically described otherwise or if theone or more features would make an embodiment non-functional.

In some instances well known methods, procedures, components, andcircuits have not been described in detail so as not to unnecessarilyobscure aspects of the embodiments.

This disclosure describes various instruments and portions ofinstruments in terms of their state in three-dimensional space. As usedherein, the term “position” refers to the location of an object or aportion of an object in a three-dimensional space (e.g., three degreesof translational freedom along Cartesian x-, y-, and z-coordinates). Asused herein, the term “orientation” refers to the rotational placementof an object or a portion of an object (three degrees of rotationalfreedom—e.g., roll, pitch, and yaw). As used herein, the term “pose”refers to the position of an object or a portion of an object in atleast one degree of translational freedom and to the orientation of thatobject or portion of the object in at least one degree of rotationalfreedom (up to six total degrees of freedom). As used herein, the term“shape” refers to a set of poses, positions, or orientations measuredalong an object.

FIGS. 1-8 illustrate various embodiments of energy delivery systems. Insome embodiments, the energy delivery systems are used for tissueablation, causing an increase in a temperature of an anatomic targetarea by transmitting electromagnetic waves from the energy deliverysystem to the anatomic target area, or ablation site. To preventexcessive heating that may cause unwanted damage to patient tissue, theenergy delivery system may be cooled by fluid as disclosed in thefollowing embodiments. In some embodiments, the energy delivery systemsmay be flexible and suitable for use in, for example, surgical,diagnostic, therapeutic, ablative, and/or biopsy procedures. In someembodiments, the energy delivery systems may be used as a medicalinstrument in an image-guided medical procedure performed with ateleoperated medical system as described in further detail below. Whilesome embodiments are provided herein with respect to such procedures,any reference to medical or surgical instruments and medical or surgicalmethods is non-limiting. In some embodiments, the energy deliverysystems may be used for non-teleoperational or non-robotic proceduresinvolving traditional manually operated medical instruments. Thesystems, instruments, and methods described herein may be used foranimals, human cadavers, animal cadavers, portions of human or animalanatomy, non-surgical diagnosis, as well as for industrial systems andgeneral robotic, general teleoperational, or robotic medical systems.

As shown in FIG. 1, an energy delivery system 100 generally includes aflexible antenna instrument 102 which includes an antenna 104 extendingfrom an elongate transmission member 106. The antenna 104 extendsbetween a proximal end 108 and a distal end 110. The elongatetransmission member 106 includes an outer conductor 112 at leastpartially surrounding an inner conductor 116 and includes an insulator114 (e.g., a dielectric layer) substantially surrounding the innerconductor 116, insulating the outer conductor 112 from the innerconductor 116. In this embodiment, the insulator 114 and the innerconductor 116 extend distally beyond the outer conductor 112. In thisembodiment, elongate transmission member 106 is a coaxial cable but forsimplicity, jacket layers and other details may not be illustrated.Other coaxial cable configurations with different configurations,shapes, etc. of inner conductor, outer conductor, and dielectric layerscould also be used. In alternative embodiments, any type of elongatetransmission member may be used for the antenna instrument 102.

In this embodiment, antenna 104 is a helical dipole antenna extendingalong a longitudinal axis A and may be used to radiate microwave energyfor use in the tissue ablation process. More specifically, antenna 104is used to create electromagnetic radiation within a wavelength range ofone meter to one millimeter, and within a frequency range ofapproximately 300 Megahertz (MHz) TO 300 Gigahertz (GHz) (e.g., amicrowave). A microwave, which is a type of radio wave, is made up of amagnetic field at a right angle to an electric field, and both themagnetic field and the electric field oscillate at a specific frequencyand travel together along a direction that is perpendicular to both themagnetic field and the electric field. In some embodiments, thewavelength and the frequency of the microwaves being radiated by antenna104 may be modified to cause a desired type of ablation at the ablationtarget site.

In this embodiment, the dipole antenna 104 includes a portion 118 ofinner conductor 116 distal of the outer conductor 112 as a first arm ofthe dipole antenna 104. A conductive coil 120 is wound around theinsulator 114 surrounding the portion 118 of inner conductor 116. Thecoil 120, which may be a helically shaped coil, forms a second arm ofthe dipole antenna 104. The coil 120 may be looped around an outerperimeter of the exposed portion of insulator 114 a plurality of timesto form a spiral-shape. The insulator 114 may insulate the outerconductor 112 from the inner conductor 116 and also insulate the innerconductor 116 from the coil 120. The coil 120 may be electricallycoupled (e.g., soldered) to outer conductor 112 by an electricalcoupling 122.

In some embodiments, the material of the insulator 114 may be chosen toprovide a high axial stiffness along axis A to allow greater rigidity topuncture tissue. Rigid materials such as polyetheretherketone (PEEK) orpolyetherimide (e.g. Ultem) may be used, for example, to increasestiffness in the antenna and prevent buckling during a punctureoperation.

In some embodiments, the coil 120 may extend along the entire length L1of portion 118 of the inner conductor 116 or along a substantial portionof length L1 (e.g. from 90% to 100%) to allow bending stiffness andmechanical properties of the entire antenna 104 to be uniform,particularly under bending when the antenna forms a constant curvature.In some embodiments, the coil 120 may extend only partially along thelength L1 of portion 118 of the inner conductor. In some otherembodiments, the coil 120 may be a double-helix coil extending alongopposing sides of inner conductor 116 and insulator 114. In some otherembodiments, coil 120 may wrap back over itself in an overlapped coilshape. In some embodiments, coil 120 may include two tubes woundtogether to create a helically wound double coil. In some embodiments,coil 120 may extend only partially along the exposed surface of theinner conductor. In alternative embodiments, coil 120 may be configuredin any way that facilitates operation of antenna instrument 102 asdescribed herein.

A barrier layer 126 extends along the antenna instrument 102, creating abarrier or seal to prevent inward migration of fluid. The barrier layer126 may be formed of a thermoplastic such as polyethylene terephthalate(PET) or other flexible and fluid insulating and impermeable materials.The barrier layer 126 may be thin and form fit around the components ofthe antenna instrument 102 or may maintain a flexible tubular form. Insome embodiments, the barrier layer may provide added rigidity tosupport the antenna 104.

The antenna instrument 102 is disposed within a jacket 124. In someembodiments the jacket 124 is closed, sealed, or otherwise restrictsfluid from passing into or out of the jacket. In alternativeembodiments, jacket 124 may have openings, slits, or otherwise beunsealed along any portion of jacket 124 to allow fluid to pass into thejacket or out from the jacket. The jacket may be formed from athermoplastic or other flexible and fluid impermeable materials.

A channel 128 is formed between the jacket 124 and the barrier layer 126and receives a fluid 130 to cool the antenna instrument 102. The fluid130 may be, for example, water or a saline solution. The fluid 130 maybe provided to the channel 128 from a fluid cooling system 132 that iscoupled to the channel 128. The fluid cooling system 132 may include afluid reservoir 134 and other components such as pumps, valves,refrigeration systems, suction systems, sensors (not shown). The fluidcooling system 132 can also include or be coupled to a fluid conduit 136that extends through the channel 128. The fluid 130 may be directedwithin the channel 128 through the conduit 136. In alternativeembodiments, the conduit 136 may be omitted with the fluid delivereddirectly through the channel 128 such that it contacts an inner wall ofthe channel 128. In some embodiments the fluid cooling system 132 may bean open loop system, a partially open loop system, a closed loop systemor any other suitable type of cooling system. As described below, aplurality of conduits may be used, with at least one conduit providinginflow of the fluid 130 to the channel 128 (for a partially open loop orclosed loop system) and at least one conduit providing a return flow toremove fluid 130 from the channel 128.

The conduit 136 may include tubing made of braided tubing or nitinoltubing that provides mechanical properties needed for spring back andstiffness (to reduce trajectory error). If constructed from nitinol, thetubing can be laser cut or ground to adjust stiffness over the length ofthe channel. This can provide for a gradual transition and eliminatekinking near the antenna body. In some embodiments, nitinol is requiredonly near a distal end portion of the channel so, to reduce costs, aproximal length of the channel can be made of polyimide or plastic and adistal end portion can be nitinol glued to the proximal length. In someembodiments, a fluorinated ethylene propylene (FEP) layer may surroundthe conduit 136. A minimum wall thickness of the conduit 136 may benecessary to prevent kinking of the channel. The wall thickness may,however, limit the overall cross sectional area of other componentswithin the device in order to maintain a desired total outer diameter.

In alternative embodiments, the structure of the coil 120 may beselected to mitigate overheating of the coil. For example, an antennaformed from a large diameter wire forming the coil paired with a largediameter inner conductor may generate less heat than an antenna formedfrom a small diameter wire forming the coil paired with a small diameterinner conductor. However, the thicker coil wire may reduce the antennaflexibility and increase the antenna's likelihood of deformation. Thus,in some embodiments, a wire diameter may be chosen to provide for adesired device flexibility while minimizing heat generation.

FIG. 2A is a cross-sectional side view of an energy delivery system 150.The energy delivery system 150 generally includes a flexible antennainstrument 152 which includes a dipole antenna 154 extending from anelongate transmission member 156. The elongate transmission member 156includes the outer conductor 112 at least partially surrounding theinner conductor 116 and includes an insulator 164 (e.g. a dielectriclayer) substantially surrounding the inner conductor 116, insulating theouter conductor 112 from the inner conductor 116. The outer conductor112 and inner conductor 116, may be substantially similar to thepreviously described structures with the same reference numerals. Inthis embodiment, the insulator 164 includes a pointed tip 166, a section168 having a width (e.g. a diameter) D1, and a section 170 having awidth (e.g. a diameter) D2. In this embodiment, D1 is larger than D2which may help in construction of the pointed tip 166 by providing morematerial to form the pointed tip 166 while still maintaining a smalleroverall outer diameter for the antenna 154. The pointed tip 166 of theinsulator 164 may allow the antenna instrument 152 to more easilypuncture anatomic tissue. In some embodiments, the pointed tip 166 maybe formed in any shape including any number of faces forming the tip, atany angle and/or with any ratio of sizes (e.g. width vs. length) thatwill optimize tissue penetration. Various tips for optimizing tissuepenetration are described in co-pending U.S. Patent Application docket#ISRG13660/US filed Oct. 31, 2019, disclosing “Tissue Penetrating DeviceTips,” which is incorporated by reference herein in its entirety.

A conductive coil 172 (which may be substantially similar to coil 120,with differences as described) is wrapped around the section 170 of theinsulator 164 forming the second arm of the dipole antenna 154. Theconductive coil 172 may be tightly coiled around the insulator 164 suchthat an inner diameter D3 of the coil 172 is approximately the same orjust slightly larger than the outer diameter D2 of the insulator 164. Inthis embodiment, an outer diameter D4 of the coil 172 is approximatelythe same as or smaller than the outer diameter D5 of the transmissionmember 156, allowing for better fluid flow around the conductive coil172 in some embodiments. In alternative embodiments, the coil 172 may bemore loosely wound such that the outer diameter D4 of the coil 172 islarger than the outer diameter D5 of the transmission member.

The energy delivery system 150 includes a barrier layer 176 extendingalong the antenna instrument 152, creating a barrier or seal to preventinward migration of fluid. The barrier layer 176 may be formed of athermoplastic or other flexible and fluid impermeable materials. Thebarrier layer 176 may form fit around the components of the antennainstrument 102 or may maintain a flexible tubular form. In someembodiments, the barrier layer 176 may provide added rigidity to supportthe antenna 154. As shown in this embodiment, the barrier layer 176 mayterminate at and be bonded to the insulator 164 at the section 168.

The energy delivery system 150 also includes a jacket 174 extendingalong the antenna instrument 152. A channel 178 is formed between thejacket 174 and the barrier layer 176. In this embodiment, the jacket 174includes a balloon portion 180 adjacent to the antenna 154 that allowsthe channel 178 to expand to accommodate cooling fluid. A distal portionof the jacket 174 may be bonded to the insulator 164 and/or to thebarrier layer 176 by a bonding material 182 to seal the jacket andprevent migration of fluid beyond the jacket.

The energy delivery system 150 also comprises the fluid cooling system132, including the fluid reservoir 134 and may be coupled to or includethe fluid conduit 136. In this embodiment, the fluid conduit 136 mayterminate proximal to, at, or near the distal end of the outer conductor112. In alternative embodiments, the fluid conduit 136 may extenddistally of the outer conductor 112. As fluid 130 is directed into thechannel 178, a cavity 184 formed by the barrier layer 176 and theballoon portion 180 of the jacket 174 may fill with the fluid 130. Thefluid 130 in the cavity 184 may surround and cool the coil 172. In someembodiments, the fluid 130 may be evacuated from the channel 178 and thecavity 184 via a negative pressure that directs the fluid around thefluid conduit 136 in a direction opposite the direction of delivery flowthrough the conduit 136. In some embodiments, the fluid 130 may beevacuated from the channel 178 by a reverse flow through the fluidconduit 136. Various other embodiments for delivering and evacuatingfluid are described below.

FIG. 2B is a cross-sectional side view of an energy delivery system 200.Energy delivery system 200 may be substantially similar to energydelivery system 150 with the differences as described. In thisembodiment, a ring 202 may extend around the section 170 of insulator164. A distal portion of the jacket 174 may be bonded to the ring 202 toform a seal that prevents migration of fluid beyond the jacket. In thisembodiment, the barrier layer 176 may be bonded to the insulator 164. Insome embodiments, the ring may be formed of a PEBAX nylon or othermaterials that bond with the jacket 174 to create a seal between thering and the jacket.

FIG. 3A is an exploded cross-sectional side view of an energy deliverysystem 220. FIG. 3B is an assembled view of the energy delivery system220. Energy delivery system 220 may be substantially similar to energydelivery system 100 with the differences as described. In thisembodiment, an assembly 221 comprising an outer jacket 224 and a tipsection 222 are assembled separately from the assembly of the antennainstrument 102. In some embodiments, the tip section could include ahollow area as shown so that the center of the antenna could nestle intothe tip section, allowing the center conductor and the dielectric toprovide better rigidity. In that embodiment, the antenna 114 (stillsurrounded by the barrier layer 126) may be shaped with a smallerdiameter extension which would fit within the hollow. As shown in FIG.3B, the antenna instrument 102 and the conduit 136 may be inserted intothe assembly 221 and fitted together to form the energy delivery system220. In this embodiment, the outer jacket 224 is coupled to and sealedwith the tip section 222, such that fluid from the assembly 221 isprevented from migrating outside of the outer jacket 224. In alternativeembodiments, jacket 224 may have openings, slits, or otherwise beunsealed along any portion of jacket 224 to allow fluid to pass into thejacket or out from the jacket. The jacket may be formed from athermoplastic or other flexible and fluid impermeable materials. The tipsection 222 is pointed and may be more rigid than the jacket 224. Thetip section 222 be formed of the same material as or a material similarto the insulator 114. For example, the tip section 222 may be formed ofa dielectric material. In one embodiment, as shown in FIG. 3C, amonolithic jacket and tip structure 260 may be formed such that the tip262 may be formed from the same material as the jacket 264. To form thistip, a glass mold can be heated and used to melt the end of the jackettube into the desired shape (conical, dome, etc.)

In another embodiment, as shown in FIG. 3D, a jacket/tip structure 270includes a tip 272 attached to a jacket 274. In this case, depending onthe materials that are used, a glue joint or mechanical joint, forexample can be used. In the case of a mechanical joint, ridges 276and/or slots 278 or other types of grooves or attachment features can bemachined into the side of the tip 272. The jacket 274 may be melted intoand or onto these attachment features to forma mechanical bond. In someembodiments, the jacket may be constructed of a material which flows asit is melted, such as FEP. If an adhesive such as glue is used, the twomaterials may need to be prepared according to manufacturinginstructions in order join the materials together.

In some embodiments, the antenna instrument 102 may be off-center orotherwise not coaxially with the assembly 221, providing a largerchannel 128 for the conduit 136. The larger channel 128 may allow for alarger diameter conduit 136 or multiple conduits to provide sufficientfluid volume.

FIGS. 4A and 4B are a cross-sectional side views and a cross-sectionalend view, respectively, of an energy delivery system 250. Energydelivery system 200 may be substantially similar to energy deliverysystem 100 with the differences as described. In this embodiment, thefluid cooling system 132 includes or may be coupled to fluid conduit 136aligned generally parallel with a conduit 137 (illustrated in FIG. 4B),both conduits extending with the channel 128. In one example, conduit136 may supply fluid 130 along the elongate transmission member 106 anddeliver the fluid to portion of the channel 128 surrounding the antenna104. The conduit 137 may provide a suction force to evacuate the fluid130 from the channel 128. In this embodiment, the flow of fluid 130 inthe conduit 136 is opposite the flow of fluid in the conduit 137. Insome embodiments, multiple conduits may be arranged radially around theantenna instrument 102, providing multiple routes for delivery andevacuation of fluid. In some embodiments, the delivery and evacuationconduits may be connected such that the fluid circulates entirely withinthe conduits without being released into the channel 128. In variousembodiments, the conduits 136, 137 may terminate at any length along theantenna instrument 102.

FIG. 5 is a cross-sectional end view of an energy delivery system 300.Energy delivery system 300 may be substantially similar to energydelivery system 100 with the differences as described. In thisembodiment, the fluid cooling system 132 includes a divider 301 whichextends within channel 310 formed between jacket 124 and barrier layer126. The divider 301 can extend along the length of the antennainstrument 102 and is connected between interior walls of the jacket124. The divider 301 may terminate at any length along the antennainstrument 102. The jacket 124 and the divider 301 define a D-shapedchannel 302 through which the fluid 130 may be delivered and evacuated.

FIG. 6 is a cross-sectional end view of an energy delivery system 350.Energy delivery system 350 may be substantially similar to energydelivery system 100 with the differences as described. In thisembodiment, the fluid cooling system 132 includes a plurality ofdividers 304 which each extend within channel 312 formed between jacketand barrier layer 126. Each of the dividers 304 can extend within thechannel 128 along the length of the antenna instrument 102. The dividers304 are connected between the interior wall of the jacket 124 and thebarrier layer 126. The dividers 304 may terminate at any length alongthe antenna instrument 102. The jacket 124, the barrier layer 126, andthe dividers 304 define radially-arranged, arc-shaped sub-channels 305through which the fluid 130 may be delivered and evacuated. For example,a plurality of the sub-channels 305 may be used for fluid delivery and aplurality of the sub-channels may be used for fluid evacuation. In someembodiments, one or more of the dividers 304 may terminate at adifferent lengths along the longitudinal axis of the antenna instrument102 to, for example, accommodate the cooling of areas of uneven heatingin the antenna.

FIG. 7 is a cross-sectional view of an energy delivery system 400.Energy delivery system 400 may be substantially similar to energydelivery system 100 with the differences as described. In thisembodiment, the fluid cooling system 132 includes an elongate tubulardivider 306 extending within the channel 128, along the length of theantenna instrument 102. In some embodiments, the divider 306 may begenerally concentric with the antenna instrument 102. The divider 306may terminate at any length along the antenna instrument 102. The jacket124, the barrier layer 126, and the divider 306 define concentricring-shaped sub-channels 307, 308 through which the fluid 130 may bedelivered and evacuated. For example, an inner sub-channel 307 may beused for fluid delivery and an outer sub-channel 308 may be used forfluid evacuation.

FIG. 8 is a cross-sectional side view of an energy delivery system 500.Energy delivery system 500 may be substantially similar to energydelivery system 150 with the differences as described. In thisembodiment, a ring-shaped plug 508 is positioned at a distal end of andco-axial with the outer conductor 112, around the insulator 164. Inalternative embodiments, the plug 508 may be positioned more proximal,around the distal end portion of the outer conductor 112. The plug maybe formed from a polymer material. An outer jacket 504 extends along theantenna instrument 102. In this embodiment. the outer jacket 504 isclosed, sealed, or otherwise restricts fluid from passing into or out ofthe jacket. In alternative embodiments, a jacket may have openings,slits, or otherwise be unsealed along any portion of jacket to allowfluid to pass into the jacket or out from the jacket. The jacket may beformed from a thermoplastic or other flexible and fluid impermeablematerials. A distal end portion of the jacket 504 is bonded to theinsulator 164. The plug 508 is bonded to or otherwise abuts the jacket504 to create a seal preventing migration of fluid 130 from the channel178 into an area around the antenna 154. In this embodiment, fluid 130delivered by the conduit 136 may be evacuated around the conduit 136,through the channel 178. A barrier layer 506 may surround the outerconductor 112 to prevent contact with the fluid 130. The barrier layer506 may be sealed using, for example a glue or other adhesive material,to prevent fluid from migrating into contact with the outer conductor112.

FIG. 9 illustrates a method 600 for transferring energy to an ablationtarget site according to some embodiments. The method 600 is illustratedas a set of operations or processes 602 through 608. Not all of theillustrated processes 602 through 608 may be performed in allembodiments of method 600. Additionally, one or more processes that arenot expressly illustrated in FIG. 9 may be included before, after, inbetween, or as part of the processes 602 through 608. In someembodiments, one or more of the processes 602 through 608 may beimplemented, at least in part, in the form of executable code stored onnon-transitory, tangible, machine-readable media that when run by one ormore processors (e.g., the processors of a control system) may cause theone or more processors to perform one or more of the processes. In oneor more embodiments, the one or more of the processes may be performedby a control system (e.g., control system 712).

At a process 602, a cooling fluid, such as cooling fluid 130, may bereceived through a channel (e.g., channel 128, 178) to cool an antenna,such as dipole antenna 104, 154 or any of the previously describedantennas. The cooling fluid may also be used to dissipate heat from thetarget tissue and/or the transmission member coupled to the antenna. Asdescribed above, the cooling fluid may be delivered by a fluid coolingsystem such as system 132. The process 602 may continue while all orsome of the processes 604-608 are performed. At an optional process 604,the antenna may be positioned near a target site to perform an ablation.At a process 606, energy may be conducted through the transmissionmember (e.g., transmission member 106, 156) to the antenna. At a process608, energy may be radiated from the antenna to ablate target patienttissue. In various embodiments, the temperature, delivery flow rate, andevacuation flow rate of the fluid may be controlled by operatorselection or altered in a closed-loop fashion automatically undercontrol of a computer processor based on sensor feedback during any ofthe processes 602-608.

FIG. 12 illustrates a method 900 for manufacturing an energy deliverysystem (e.g., similar to system 220 or others previously described). Notall of the illustrated processes of method 900 may be performed in allembodiments. Additionally, one or more processes that are not expresslyillustrated in FIG. 12 may be included before, after, in between, or aspart of the illustrated processes.

At a process 902, a jacket (e.g. jacket 224) may be connected to a tipsection (e.g., tip section 222). At a process 904, an antenna instrumentmay be assembled by connecting the coil (e.g. coil 120) around theinsulator (e.g., insulator 114) and connecting the coil to the elongatetransmission member (e.g., elongate transmission member 106). In someembodiments, a barrier layer may also be extend over the antennainstrument. At a process 906, the antenna instrument may be insertedinto the central lumen of the jacket and coupled to the tip section.Similarly, the cooling fluid conduit(s)(e.g. fluid conduit 136) may beinserted into the central lumen of the jacket. At a process 908,proximal end components including components of the fluid cooling system132, handles, and/or connectors may be coupled to the proximal end ofthe antenna assembly.

FIG. 13 illustrates a method 950 for manufacturing an energy deliverysystem (e.g., similar to system 300 or others previously described). Notall of the illustrated processes of method 950 may be performed in allembodiments. Additionally, one or more processes that are not expresslyillustrated in FIG. 13 may be included before, after, in between, or aspart of the illustrated processes.

At a process 952, a jacket including multiple lumens or channels (e.g.channels 310, 302) may be coupled at a distal end to a single lumenjacket portion. The single lumen jacket portion may provide a transitionarea to allow fluid to flow from a delivery channel such as channel 302into a return channel such as channel 310. At a process 954, an antennainstrument may be assembled by connecting the coil (e.g. coil 120)around the insulator (e.g., insulator 114) and connecting the coil tothe elongate transmission member (e.g., elongate transmission member106). In some embodiments, a barrier layer may also be extend over theantenna instrument. At a process 956, the antenna instrument may beinserted into the central lumen of the jacket assembly. The antennainstrument may be inserted from the proximal or distal end of the jacketassembly. At a process 958, the tip section may be coupled to the jacketassembly and the antenna instrument. At a process 960, proximal endcomponents including components of the fluid cooling system 132,handles, and/or connectors may be coupled to the proximal end of theantenna assembly.

In various embodiments, any of the described energy delivery systems maybe may be used as a medical instrument delivered by, coupled to, and/orcontrolled by a robotic teleoperated and/or non-teleoperated medicalsystem. FIG. 10 is a simplified diagram of a teleoperated medical system700 according to some embodiments. In some embodiments, teleoperatedmedical system 700 may be suitable for use in, for example, surgical,diagnostic, therapeutic, or biopsy procedures. While some embodimentsare provided herein with respect to such procedures, any reference tomedical or surgical instruments and medical or surgical methods isnon-limiting. The systems, instruments, and methods described herein maybe used for animals, human cadavers, animal cadavers, portions of humanor animal anatomy, non-surgical diagnosis, as well as for industrialsystems and general robotic or teleoperational systems.

As shown in FIG. 10, medical system 700 generally includes a manipulatorassembly 702 for operating a medical instrument 704 in performingvarious procedures on a patient P positioned on a table T. In someembodiments, the medical instrument 704 may include, deliver, couple to,and/or control any of the antenna instruments described herein. Themanipulator assembly 702 may be teleoperated, non-teleoperated, or ahybrid teleoperated and non-teleoperated assembly with select degrees offreedom of motion that may be motorized and/or teleoperated and selectdegrees of freedom of motion that may be non-motorized and/ornon-teleoperated. Master assembly 706 generally includes one or morecontrol devices for controlling manipulator assembly 702. Manipulatorassembly 702 supports medical instrument 704 and may optionally includea plurality of actuators or motors that drive inputs on medicalinstrument 704 in response to commands from a control system 712. Theactuators may optionally include drive systems that when coupled tomedical instrument 704 may advance medical instrument 704 into anaturally or surgically created anatomic orifice. Other drive systemsmay move the distal end of medical instrument 704 in multiple degrees offreedom, which may include three degrees of linear motion (e.g., linearmotion along the X, Y, Z Cartesian axes) and in three degrees ofrotational motion (e.g., rotation about the X, Y, Z Cartesian axes).Additionally, the actuators can be used to actuate an articulable endeffector of medical instrument 704 for grasping tissue in the jaws of abiopsy device and/or the like. Actuator position sensors such asresolvers, encoders, potentiometers, and other mechanisms may providesensor data to medical system 700 describing the rotation andorientation of the motor shafts. This position sensor data may be usedto determine motion of the objects manipulated by the actuators.

Teleoperated medical system 700 also includes a display system 710 fordisplaying an image or representation of the surgical site and medicalinstrument 704 generated by sub-systems of sensor system 708 and/or anyauxiliary information related to a procedure including informationrelated to ablation (e.g. temperature, impedance, energy delivery powerlevels, frequency, current, energy delivery duration, indicators oftissue ablation, etc.). Display system 710 and master assembly 706 maybe oriented so operator O can control medical instrument 704 and masterassembly 706 with the perception of telepresence.

In some embodiments, medical instrument 704 may include components of animaging system, which may include an imaging scope assembly or imaginginstrument that records a concurrent or real-time image of a surgicalsite and provides the image to the operator or operator O through one ormore displays of medical system 700, such as one or more displays ofdisplay system 710. The concurrent image may be, for example, a two orthree-dimensional image captured by an imaging instrument positionedwithin the surgical site. In some embodiments, the imaging systemincludes endoscopic imaging instrument components that may be integrallyor removably coupled to medical instrument 704. However, in someembodiments, a separate endoscope, attached to a separate manipulatorassembly may be used with medical instrument 704 to image the surgicalsite. In some embodiments, the imaging system includes a channel (notshown) that may provide for a delivery of instruments, devices,catheters, and/or the antenna instruments described herein. The imagingsystem may be implemented as hardware, firmware, software or acombination thereof which interact with or are otherwise executed by oneor more computer processors, which may include the processors of thecontrol system 712.

Teleoperated medical system 700 may also include control system 712.Control system 712 includes at least one memory and at least onecomputer processor (not shown) for effecting control between medicalinstrument 704, master assembly 706, sensor system 708, and displaysystem 710. Control system 712 also includes programmed instructions(e.g., a non-transitory machine-readable medium storing theinstructions) to implement some or all of the methods described inaccordance with aspects disclosed herein, including instructions forproviding information to display system 710.

Control system 712 may optionally further include a virtualvisualization system to provide navigation assistance to operator O whencontrolling medical instrument 704 during an image-guided surgicalprocedure. Virtual navigation using the virtual visualization system maybe based upon reference to an acquired preoperative or intraoperativedataset of anatomic passageways. The virtual visualization systemprocesses images of the surgical site imaged using imaging technologysuch as computerized tomography (CT), magnetic resonance imaging (MRI),fluoroscopy, thermography, ultrasound, optical coherence tomography(OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-rayimaging, and/or the like.

FIG. 11A is a simplified diagram of a medical instrument system 800according to some embodiments. Medical instrument system 800 includeselongate device 802, such as a flexible catheter, coupled to a driveunit 804. Elongate device 802 includes a flexible body 816 havingproximal end 817 and distal end or tip portion 818. Medical instrumentsystem 800 further includes a tracking system 830 for determining theposition, orientation, speed, velocity, pose, and/or shape of distal end818 and/or of one or more segments 824 along flexible body 816 using oneor more sensors and/or imaging devices as described in further detailbelow.

Tracking system 830 may optionally track distal end 818 and/or one ormore of the segments 824 using a shape sensor 822. Shape sensor 822 mayoptionally include an optical fiber aligned with flexible body 816(e.g., provided within an interior channel (not shown) or mountedexternally). The optical fiber of shape sensor 822 forms a fiber opticbend sensor for determining the shape of flexible body 816. In onealternative, optical fibers including Fiber Bragg Gratings (FBGs) areused to provide strain measurements in structures in one or moredimensions. Various systems and methods for monitoring the shape andrelative position of an optical fiber in three dimensions are describedin U.S. patent application Ser. No. 11/180,389 (filed Jul. 13, 2005)(disclosing “Fiber optic position and shape sensing device and methodrelating thereto”); U.S. patent application Ser. No. 12/047,056 (filedon Jul. 16, 2004) (disclosing “Fiber-optic shape and relative positionsensing”); and U.S. Pat. No. 6,389,187 (filed on Jun. 17, 1998)(disclosing “Optical Fibre Bend Sensor”), which are all incorporated byreference herein in their entireties. In some embodiments, trackingsystem 830 may optionally and/or additionally track distal end 818 usinga position sensor system 820. Position sensor system 820 may be acomponent of an EM sensor system with position sensor system 820including one or more conductive coils that may be subjected to anexternally generated electromagnetic field. In some embodiments,position sensor system 820 may be configured and positioned to measuresix degrees of freedom, e.g., three position coordinates X, Y, Z andthree orientation angles indicating pitch, yaw, and roll of a base pointor five degrees of freedom, e.g., three position coordinates X, Y, Z andtwo orientation angles indicating pitch and yaw of a base point. Furtherdescription of a position sensor system is provided in U.S. Pat. No.6,380,732 (filed Aug. 11, 1999)(disclosing “Six-Degree of FreedomTracking System Having a Passive Transponder on the Object BeingTracked”), which is incorporated by reference herein in its entirety. Insome embodiments, an optical fiber sensor may be used to measuretemperature or force. In some embodiments, a temperature sensor, a forcesensor, an impedance sensor, or other types of sensors may be includedwithin the flexible body.

Flexible body 816 includes a channel 821 sized and shaped to receive amedical instrument 826. In various embodiments, any of the antennainstruments described above may be inserted through the channel 821 ofthe flexible body 816. FIG. 11B is a simplified diagram of flexible body816 with medical instrument 826 extended according to some embodiments.In some embodiments, medical instrument 826 may be used for proceduressuch as imaging, visualization, surgery, biopsy, ablation, illumination,irrigation, or suction. Medical instrument 826 can be deployed throughchannel 821 of flexible body 816 and used at a target location withinthe anatomy. Medical instrument 826 may include, for example, imagecapture probes, biopsy instruments, laser ablation fibers, and/or othersurgical, diagnostic, or therapeutic tools. Medical instrument 826 maybe used with an imaging instrument (e.g., an image capture probe) alsowithin flexible body 816. The imaging instrument may include a cablecoupled to the camera for transmitting the captured image data. In someexamples, the imaging instrument may be a fiber-optic bundle, such as afiberscope, that couples to image processing system 831. The imaginginstrument may be single or multi-spectral, for example capturing imagedata in one or more of the visible, infrared, and/or ultravioletspectrums. Medical instrument 826 may be advanced from the opening ofchannel 821 to perform the procedure and then retracted back into thechannel when the procedure is complete. Medical instrument 826 may beremoved from proximal end 817 of flexible body 816 or from anotheroptional instrument port (not shown) along flexible body 816.

Flexible body 816 may also house cables, linkages, or other steeringcontrols (not shown) that extend between drive unit 804 and distal end818 to controllably bend distal end 818 as shown, for example, by brokendashed line depictions 819 of distal end 818. In some examples, at leastfour cables are used to provide independent “up-down” steering tocontrol a pitch of distal end 818 and “left-right” steering to control ayaw of distal end 818. Steerable elongate devices are described indetail in U.S. patent application Ser. No. 13/274,208 (filed Oct. 14,2011) (disclosing “Catheter with Removable Vision Probe”), which isincorporated by reference herein in its entirety.

The information from tracking system 830 may be sent to a navigationsystem 832 where it is combined with information from image processingsystem 831 and/or the preoperatively obtained models to provide theoperator with real-time position information. In some examples, thereal-time position information may be displayed on display system 710 ofFIG. 10 for use in the control of medical instrument system 800. In someexamples, control system 712 of FIG. 10 may utilize the positioninformation as feedback for positioning medical instrument system 800.Various systems for using fiber optic sensors to register and display asurgical instrument with surgical images are provided in U.S. patentapplication Ser. No. 13/107,562, filed May 13, 2011, disclosing,“Medical System Providing Dynamic Registration of a Model of an AnatomicStructure for Image-Guided Surgery,” which is incorporated by referenceherein in its entirety.

In some examples, medical instrument system 800 may be teleoperatedwithin medical system 700 of FIG. 10. In some embodiments, manipulatorassembly 706 of FIG. 10 may be replaced by direct operator control. Insome examples, the direct operator control may include various handlesand operator interfaces for hand-held operation of the instrument.

One or more elements in embodiments of this disclosure may beimplemented in software to execute on a processor of a computer systemsuch as control processing system. When implemented in software, theelements of the embodiments of the invention are essentially the codesegments to perform the necessary tasks. The program or code segmentscan be stored in a processor readable storage medium or device that mayhave been downloaded by way of a computer data signal embodied in acarrier wave over a transmission medium or a communication link. Theprocessor readable storage device may include any medium that can storeinformation including an optical medium, semiconductor medium, andmagnetic medium. Processor readable storage device examples include anelectronic circuit; a semiconductor device, a semiconductor memorydevice, a read only memory (ROM), a flash memory, an erasableprogrammable read only memory (EPROM); a floppy diskette, a CD-ROM, anoptical disk, a hard disk, or other storage device. The code segmentsmay be downloaded via computer networks such as the Internet, Intranet,etc. Any of a wide variety of centralized or distributed data processingarchitectures may be employed. Programmed instructions may beimplemented as a number of separate programs or subroutines, or they maybe integrated into a number of other aspects of the systems describedherein. In one embodiment, the control system supports wirelesscommunication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11,DECT, and Wireless Telemetry.

Medical tools that may be delivered through the flexible elongatedevices or catheters disclosed herein may include, for example, imagecapture probes, biopsy instruments, laser ablation fibers, and/or othersurgical, diagnostic, or therapeutic tools. Medical tools may includeend effectors having a single working member such as a scalpel, a bluntblade, an optical fiber, an electrode, and/or the like. Other endeffectors may include, for example, forceps, graspers, scissors, clipappliers, and/or the like. Other end effectors may further includeelectrically activated end effectors such as electrosurgical electrodes,transducers, sensors, and/or the like. Medical tools may include imagecapture probes that include a stereoscopic or monoscopic camera forcapturing images (including video images). Medical tools mayadditionally house cables, linkages, or other actuation controls (notshown) that extend between its proximal and distal ends to controllablybend the distal end of antenna instrument 102. Steerable instruments aredescribed in detail in U.S. Pat. No. 7,416,681 (filed on Oct. 4, 2005)(disclosing “Articulated Surgical Instrument for Performing MinimallyInvasive Surgery with Enhanced Dexterity and Sensitivity”) and U.S.patent application Ser. No. 12/286,644 (filed Sep. 30, 2008) (disclosing“Passive Preload and Capstan Drive for Surgical Instruments”), which areincorporated by reference herein in their entireties.

The systems described herein may be suited for navigation and treatmentof anatomic tissues, via natural or surgically created connectedpassageways, in any of a variety of anatomic systems, including thelung, colon, stomach, the intestines, the kidneys and kidney calices,bladder, liver, gall bladder, pancreas, spleen, the ureter, ovaries,uterus, the brain, the circulatory system including the heart,vasculature, and/or the like.

Note that the processes and displays presented may not inherently berelated to any particular computer or other apparatus. Variousgeneral-purpose systems may be used with programs in accordance with theteachings herein, or it may prove convenient to construct a morespecialized apparatus to perform the operations described. The requiredstructure for a variety of these systems will appear as elements in theclaims. In addition, the embodiments of the invention are not describedwith reference to any particular programming language. It will beappreciated that a variety of programming languages may be used toimplement the teachings of the invention as described herein.

While certain exemplary embodiments of the invention have been describedand shown in the accompanying drawings, it is to be understood that suchembodiments are merely illustrative of and not restrictive on the broadinvention, and that the embodiments of the invention not be limited tothe specific constructions and arrangements shown and described, sincevarious other modifications may occur to those ordinarily skilled in theart.

1-20. (canceled)
 21. An energy delivery system comprising: atransmission member; an antenna at a distal end of the transmissionmember; a jacket surrounding the transmission member and the antenna; afluid channel between the transmission member and the jacket; and a plugdisposed at a distal end of the fluid channel, the plug configured toprevent migration of a cooling fluid from the fluid channel to a cavitybetween the antenna and the jacket.
 22. The energy delivery system ofclaim 21, wherein the plug is disposed distally of the transmissionmember.
 23. The energy delivery system of claim 21, wherein the antennacomprises a first conductive arm, an insulator extending around thefirst conductive arm, and a second conductive arm.
 24. The energydelivery system of claim 23, wherein the second conductive arm includesa coil extending around the insulator.
 25. The energy delivery system ofclaim 23, wherein the plug comprises a ring-shaped member extendingradially from the insulator to the jacket.
 26. The energy deliverysystem of claim 23, wherein a distal section of the insulator forms apointed tip.
 27. The energy delivery system of claim 21, wherein theplug comprises a ring-shaped member extending radially from thetransmission member to the jacket.
 28. The energy delivery system ofclaim 21, further comprising: a barrier layer surrounding thetransmission member.
 29. The energy delivery system of claim 28, whereinthe plug comprises a ring-shaped member extending radially from thebarrier layer to the jacket.
 30. The energy delivery system of claim 21,further comprising: a fluid cooling system for providing the coolingfluid to the fluid channel.
 31. The energy delivery system of claim 21,further comprising: a first conduit member extending within the fluidchannel, wherein the cooling fluid is delivered through the firstconduit member.
 32. The energy delivery system of claim 31, furthercomprising: a second conduit member extending within the fluid channel,wherein the cooling fluid flows through the first conduit member in afirst direction and flows through the second conduit member in a seconddirection opposite the first direction.
 33. The energy delivery systemof claim 21, wherein the fluid channel has a D-shape.
 34. The energydelivery system of claim 21, further comprising a divider extendinglongitudinally within the fluid channel to separate a first sub-channelwherein the cooling fluid flows in a first direction from a secondsub-channel wherein the cooling fluid flows in a second direction,opposite the first direction.
 35. The energy delivery system of claim34, wherein the divider is a tube extending within and concentric withthe jacket such that the first sub-channel is concentric with the secondsub-channel.
 36. The energy delivery system of claim 21, furthercomprising: a tip section positioned distally to the antenna, whereinthe jacket is coupled to the tip section.
 37. A method for cooling anenergy delivery device, the method comprising: delivering a coolingfluid to a fluid channel formed between a transmission member and ajacket of an energy delivery device, wherein the jacket surrounds thetransmission member and an antenna positioned at a distal end of thetransmission member; and preventing migration of the cooling fluid fromthe fluid channel to a cavity between the jacket and the antenna using aplug disposed at a distal end of the fluid channel.
 38. The method ofclaim 37, further comprising: evacuating the cooling fluid from thefluid channel.
 39. The method of claim 37, further comprising:conducting energy through the transmission member; and radiating theenergy from the antenna into a target tissue.
 40. The method of claim37, further comprising: preventing the cooling fluid from contacting thetransmission member with a barrier layer disposed around thetransmission member.